Thank you for viewing this CAHP PCI Registry case scenario. In this scenario, we will cover sequence number 7825, PCI indication. A patient presented to the emergency department with complaints of chest pain and difficulty breathing that began three days ago. However, today the symptoms became so unrelenting, he couldn't walk to his front porch to get his morning newspaper. So he called 911. His workup included an ECG that demonstrated ST elevations in the anterior leads and a chest X-ray that revealed heart failure among other diagnostic tests. A cardiology consult was obtained who felt this was a late-presenting STEMI. However, due to instability and ECG changes, he immediately took him to the cath lab where PCI to the proximal LED was successful. Our question is, how is sequence number 7825, PCI indication coded in this scenario? Number one, STEMI, immediate PCI for acute STEMI. Number two, STEMI, stable, less than or equal to 12 hours from symptoms. Number three, STEMI, stable, greater than 12 hours from symptoms. Or number four, STEMI, unstable, greater than 12 hours from symptoms. Please take a few moments to review the documentation and the question prior to making your final selection. The answer is number one, STEMI, immediate PCI for acute STEMI. As PCI was performed emergently and without delay after diagnosis to meet the definition. STEMI, immediate PCI for acute STEMI is the appropriate selection in sequence number 7825, PCI indication when PCI is performed on an emergent basis and without delay after diagnosis. Patients may complain of symptoms that began less than or 12 hours prior, or there may be documentation of late presentation. However, the acute diagnosis in conjunction with immediate treatment supports coding in this manner. In fact, did you know that even though the patient complained of symptoms that began three days ago, the onset day and time is not coded in sequence number 7826 and 7827, acute coronary syndrome symptom date and time. It's true. Sequence number 7826 and 7827 are capturing the date and time the patient noted ischemic symptoms lasting greater than or equal to 10 minutes that meet the target value of the last value most recent between one week prior to current procedure and current procedure. In scenarios involving a prolonged symptom time prior to presentation, such as this, we recommend coding the most recent ischemic symptoms prior to presentation or the time at which the symptoms became constant or changed in intensity. The intent is to capture the timing of the symptoms that prompted the patient to seek medical attention, which in the scenario we reviewed today was when he couldn't walk to his front porch to get his morning newspaper. So believe it or not, we receive this type of documentation in question quite often. So we know some of you are out there banging your heads against the wall. And if you are, please stop. You'll give yourself an even bigger headache. But the next slide is going to expand on the why. The registry is relying on physician diagnosis and documentation in the medical record along with action taken. The abstraction of sequence number 7825 PCI indication should be based on the pre-procedure diagnostic testing conclusions. When patients present to the facility with symptoms greater or less than 12 hours, it would be difficult to say the onset of symptoms coincides with the diagnosis of MI. So unless there is specific documentation from the physician, such as the patient presents status post-MI with post-infarct angina, and the patient is not treated immediately based on the diagnosis, then this would support coding the patient as STEMI, stable, less than or equal to 12 hours from symptoms, or STEMI, unstable or stable, greater than 12 hours from symptoms, depending on the symptom time frame. Thank you for viewing this CAF PCI registry case scenario.

emergency department

chest pain

difficulty breathing

ST elevation

heart failure